Serum amyloid A and C‐reactive protein positive nodule in alcoholic liver cirrhosis, hard to make definite diagnosis

Abstract

We describe a case of serum amyloid A (SAA) and C-reactive protein (CRP) positive nodule detected by immunohistochemical analysis in a 37-year-old woman with alcohol-related cirrhosis. Imaging studies at first admission pointed to hepatocellular carcinoma (HCC), a dysplastic nodule, an inflammatory pseudotumor or focal nodular hyperplasia (FNH). Ultrasonography-guided biopsy in Segment 2 showed minimal atypical changes, except for a slight increase in cell density and micronodular cirrhosis in the non-nodular portion. gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging carried out after a year and a half revealed hypervascularity in the arterial phase and isointensity in the hepatobiliary phase. Three years thereafter, however, the imaging displayed a change from isointensity to a defect in the hepatobiliary phase, and the nodule demonstrated minimal histological atypia. Immunohistochemical staining of the nodule was positive for SAA, CRP, liver fatty acid-binding protein and glutamine synthetase, but negative for β-catenin, heat shock protein 70 and Glypican 3. Organic anion transporter (OATP)8 staining was weaker in the nodule than in the non-nodular portion of the alcohol-related micronodular cirrhosis. The nodule was diagnosed as an SAA and CRP positive nodule, and HCC was ruled out. Despite the change from isointensity to a defect in the hepatobiliary phase, no evidence of HCC was found in the biopsy specimen. The change may be explained more by the weak OATP8 staining compared with that of alcohol-related liver cirrhosis than by malignant transformation into HCC.

Comparison of acute phase protein and hemodynamic variables in dogs undergoing video-assisted thoracoscopic vs. open pneumonectomy

“…Levels of the APPs CRP, SAA, and YKL-40 increase as a result of the inflammatory response to infection or tissue damage, and have been used to evaluate surgery technique, infection and pathology progress. CRP and SAA levels increase in a number of pathological states, including surgical trauma (27)(28)(29)(30), esophageal neoplasia, infection with H3N2 swine influenza virus, alcoholic liver and systemic inflammation (11,(31)(32)(33)(34). In the present study, levels of all APPs increased significantly on day 1 postoperatively compared with baseline (preoperative levels) and decreased over the subsequent time point measurements.…”

Rs12218 In SAA1 gene was associated with serum lipid levels

“…Its plasma concentration can increase a 1000-fold within 24 h [9,10]. In plasma, SAA is associated with HDL-C [11,12] and, during severe inflammation, can contribute 80% of its apo-protein composition [13]. The displaced apoA-I is rapidly cleared by the liver and kidneys [14], together with a sharp decline in apoA-I gene expression during inflammation [15].…”

Hepatic Serum Amyloid A1 Aggravates T Cell-mediated Hepatitis by Inducing Chemokines via Toll-like Receptor 2 in Mice

“…In the case study of a woman with alcoholic liver cirrhosis, an existing liver nodule was diagnosed as SAA-positive by immunohistochemistry (27). These studies suggest that hepatitis might lead to increased SAA expression and that SAA can exacerbate hepatitis.…”